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General NPI Number Information
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NPI Number | 1396973053
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Entity Type | Organization
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Legal Business Name | THE SKINSTITUTE
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Dates
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Enumeration Date | 07/01/2009
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 19465 DEERFIELD AVE STE 201
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City | LEESBURG
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State | VA
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Zip | 20176-1703
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Country | US
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Telephone | 703-914-3603
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Fax | 703-914-3604
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Provider Business Mailing Address
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Address Line | 19465 DEERFIELD AVE STE 201
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City | LEESBURG
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State | VA
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Zip | 20176-1703
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Country | US
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Telephone | 703-914-3603
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SMEENA KHAN
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Credential | MD
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Telephone | 571-246-2891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 0101235906
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License Number State | VA
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